Bloomberg has an interesting article on the limited medical benefit of spinal fusion to patients–but big financial benefits to doctors, medical practices and suppliers (Medtronic). The article documents at least the appearance of, if not actual, conflicts of interest; high costs $135,000 for the surgery (yes on one patient); $800,000/year incomes for the orthopedists–three times that of pediatricians.

The possibility that many of these and other surgeries are needless has gotten little attention in the debate over U.S. health care costs, which rose 6 percent last year to $2.47 trillion. Unnecessary surgeries cost at least $150 billion a year, according to John Birkmeyer, director of the Center for Healthcare Outcomes & Policy at the University of Michigan.

“It’s amazing how much evidence there is that fusions don’t work, yet surgeons do them anyway,” said Sohail Mirza, a spine surgeon who chairs the Department of Orthopaedics at Dartmouth Medical School in Hanover, New Hampshire. “The only one who isn’t benefitting from the equation is the patient.”

There’s lots to this article including evidence that fusion is no better than physical therapy for disc related pain in several studies–only a 47% success rate for surgery in one U.S. study; high complication rates for surgery; direct payments from the medical supplier (Medtronic) in the form of royalties and consulting fees to doctors (as high as $440,000/year to an individual doctor and 1.75 million to a practice in Minneapolis).

Medicynical note: Not a pretty picture of American medicine. Costly, open conflicts of interest, use of aggressive expensive unproven procedures over more conservative approaches–with the same or worse outcomes. Is it any wonder that our costs are one and half to two times that of other industrialized countries.

The “free market” encourages entrepreneurs to find ways to take advantage of markets, sometimes that leads to better outcomes and more efficiency but in medicine it seems to encourage waste, high cost and over-utilization.